Individual provider Active NPI

John Petty, MD

  • Physical Medicine & Rehabilitation Physician
  • Kettering, OH
National Provider Identifier
1083665343
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
35038579 Issued in OH
Practice address
3535 Southern Blvd
Kettering, OH 45429-1221
Phone
(937) 395-8666
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 35038579 OH Primary

Addresses

Primary practice location

3535 Southern Blvd
Kettering, OH 45429-1221

Mailing address

PO Box 750245
Dayton, OH 45475-0245

Other identifiers 1

IdentifierTypeStateIssuer
0525640MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120208000948 OH Practitioner - Physical Medicine and Rehabilitation 6103850029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Ohio State University College of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 435-9402

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35038579OHMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Physiatrists, Inc. Physical Medicine & Rehabilitation CurrentSince Oct 1, 1989 Accepting new patients

Locations

3535 Southern Blvd
Kettering, OH 45429
Phone (937) 298-1221

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342
Phone (937) 384-8791

630 W Main St
Ste 301
Wilmington, OH 45177
Phone (937) 382-8580

630 W Main St
Wilmington, OH 45177
Phone (513) 475-8520

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1083665343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 750245",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454750245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-395-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OH",
            "license": "35038579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0525640",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.